| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,330 |
1,295 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
1,506 |
1,461 |
$34K |
| D0274 |
Bitewings - four radiographic images |
978 |
959 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,702 |
1,371 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,989 |
1,885 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
377 |
271 |
$29K |
| D1120 |
Prophylaxis - child |
460 |
448 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
374 |
260 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
302 |
298 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
707 |
691 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
501 |
488 |
$19K |
| D9110 |
|
487 |
456 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
187 |
127 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
355 |
347 |
$14K |
| D2394 |
|
58 |
40 |
$7K |
| D2330 |
|
61 |
38 |
$4K |
| D1351 |
Sealant - per tooth |
139 |
31 |
$4K |
| D2335 |
|
21 |
12 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
16 |
$2K |
| D0330 |
Panoramic radiographic image |
33 |
30 |
$2K |
| D0270 |
|
34 |
32 |
$436.00 |